Please circle your answers In the past 2 weeks how many times did problems with asthma interfere with your activities or activities you wanted to doNever 02 times 13 or more times 2How manyda ID: 936197
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Patient Asthma APGARith scores Please circle your answers: In the past 2 weeks, how many times did problems with asthma interfere with your activities or activities you wanted to do?Never (0)2 times (1)3 or more times (2)How manydays in thepast 2 weeks did you have shortness of breath, wheezing, chest Asthma Medication
When taken? Reasons for taking medication: Reason for not taking medication: Daily As needed Daily As needed Daily As needed Daily As needed A P G A R Scoring Patient ASTHMAand linking to algorithm Interpretationof APGAR score a. Score of 2 or 3---
Inadequate control requiring action Scoring: = activitiesNever = 02 time = 1 3 or more times = Case: (an exampleof training case Score is 2 with 1 for activities and 1 for daytime symptoms.No major exacerbation For Clinician useonly Activity followup questions What have you given up due to asthma?What
would you like to do that you can’t, because of asthma? Persistence follow up questions: Has the frequency and severity of your daytime symptoms been similar over the last 2 months?Has the frequency and severity of your nighttime symptoms been similar over the last 2 months? Would you like to know the difference be
tween rescue and controller medication? Y/N/UnsureDo you have or use a rescue medication? Y/N/Don’t know Show me medication or describe it. Response follow up questions: Do you thi A =Activities =Persistent=triGGers=Asthma medication=Response to therapy P =asthm a Plan =Lung function=Use of inhaler S =Steroid